Association for Public Policy Analysis & Management

Background: Overdose deaths attributed to opioid pain relievers (OPR) have quadrupled since 1999.  To reduce overprescribing many states have implemented Prescription Drug Monitoring Programs (PMP).  Most evaluations neglect variation in PMP rigor across states and over time.  Methods: We employed panel data with fixed effects to regress state-year death rates on an index variable that measures state-year PMP strength, controlling for demographic factors and laws that might affect OPR overdose. Robust standard errors were obtained by state-level clustering. Results: We report a statistically significant 1% reduction of OPR overdose death rates for every point increase in PMP strength.  A one point increase in PMP strength could have saved, on average, more than 1700 lives in the past 16 years.  When collapsed into quartiles, PMPs in the third quartile are associated with approximately 18% reduction in OPR overdose death rates compared to states absent a PMP. Surprisingly, states with medical marijuana dispensaries reported a 16-18% reduction in OPR overdoses.  Discussion: Analysis suggests that stronger PMPs are associated with reductions in OPR overdose. PMPs offer some promise, but further research is needed to determine the legal mechanisms of causality. In short, PMP design, implementation and strength matter. States should consider strengthening programs and promote complementary policies to improve prescriber practices.